Healthcare Provider Details

I. General information

NPI: 1457689143
Provider Name (Legal Business Name): MERCY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 11/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3000 Q ST
SACRAMENTO CA
95816-7058
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19332
License Number StateCA

VIII. Authorized Official

Name: NANCY SIEBER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 916-733-3411